The relationship between placental transfusion, and thymic size and neonatal morbidities in premature infants - A Randomized Control Trial

OBJECTIVE: To compare the effect of umbilical cord milking and early cord clamping on thymic size, and neonatal mortality and morbidity in preterm infants. METHODS: This single-center, prospective, double-blind, randomised controlled study was conducted at Baskent University, Konya Education and Research Centre, Konya, Turkey, between October 2015 and April 2016. Pregnant women who delivered before 32 weeks of gestation were randomised to receive umbilical cord milking (group 1) or early cord clamping (group 2). Ultrasonographic evaluation was performed in each newborn by an experienced radiologist within the first 24 hours of life. Thymic si ze was estimated in l ine with literatu re. SPSS 15 was u sed for a ll data analyses. RESULTS: There were 38 subjects in group 1 and 37 in group 2. There were as many infants in the two groups (p>0.05) The haemoglobin levels was higher in group 1, but not significantly (p=0.213). The absolute neutrophil count in group 1 was significantly lower (p= 0.017) than group 2. In terms of neonatal mortaility and morbidity, there were no significant differences between the groups (p>0.05). CONCLUSIONS: Umbilical cord milking was not associated with thymic size during the the first 24h of life.

Association of Serum Albumin Level and Mortality in Premature Infants.

BACKGROUND: Hypoalbuminemia has been proven to be a powerful predictor of mortality in adult patients. However, prognostic value of serum albumin in neonates is not clear. OBJECTIVE: To assess the relationship between serum albumin level within the first day of life and outcome in preterm infants born before 32 weeks of gestation. METHODS: The study was conducted prospectively in Baskent University Hospital between October 2008 and November 2009. Patients were divided by gestational age into two groups as below or of 28 weeks and above 28 weeks. Then serum albumin percentile groups were established within each gestational age group and were defined as <25, 25-75, and >75 percentile groups by combining percentile groups between the two gestational age groups. Three serum albumin percentile groups were compared regarding neonatal outcomes. RESULTS: A total of 199 infants with mean birth weight of 1,272 ± 390 g and mean gestational age of 29.2 ± 2.2 weeks were admitted to the study. The mean serum albumin level was 30.6 ± 4.7 g/l for all patients. The mean serum albumin levels were 25.5 ± 3.8, 30.1 ± 2.7, and 35.3 ± 3.7 g/l for <25, 25-75, and >75 percentile groups, respectively. Prevalence of infants with respiratory distress syndrome and prevalence of infants with sepsis and mortality were significantly higher in <25 percentile group. Logistic regression analysis showed that serum albumin <25 percentile and birth weight were independent predictive variables of mortality. Albumin concentrations lower than 27.2 g/l was associated with mortality, with a sensitivity of 71% and a specificity of 86%. CONCLUSION: Low serum albumin level within the first day of life is an independent predictor of mortality in preterm infants.

Left ventricular dimensions, systolic functions, and mass in term neonates with symmetric and asymmetric intrauterine growth restriction.

BACKGROUND: Previous studies have demonstrated structural changes in the heart and cardiac dysfunction in foetuses with intrauterine growth restriction. There are no available data that evaluated left ventricular dimensions and mass in neonates with symmetric and asymmetric intrauterine growth restriction. Therefore, we aimed to evaluate left ventricular dimensions, systolic functions, and mass in neonates with symmetric and asymmetric intrauterine growth restriction. We also assessed associated maternal risk factors, and compared results with healthy appropriate for gestational age neonates. METHODS: In all, 62 asymmetric intrauterine growth restriction neonates, 39 symmetric intrauterine growth restriction neonates, and 50 healthy appropriate for gestational age neonates were evaluated by transthoracic echocardiography. RESULTS: The asymmetric intrauterine growth restriction group had significantly lower left ventricular end-systolic and end-diastolic diameters and posterior wall diameter in systole and diastole than the control group. The symmetric intrauterine growth restriction group had significantly lower left ventricular end-diastolic diameter than the control group. All left ventricular dimensions were lower in the asymmetric intrauterine growth restriction neonates compared with symmetric intrauterine growth restriction neonates (p>0.05), but not statistically significant except left ventricular posterior wall diameter in diastole (3.08±0.83 mm versus 3.54 ±0.72 mm) (p<0.05). Both symmetric and asymmetric intrauterine growth restriction groups had significantly lower relative posterior wall thickness (0.54±0.19 versus 0.48±0.13 versus 0.8±0.12), left ventricular mass (9.8±4.3 g versus 8.9±3.4 g versus 22.2±5.7 g), and left ventricular mass index (63.6±29.1 g/m2 versus 54.5±24.4 g/m2 versus 109±28.8 g/m2) when compared with the control group. CONCLUSIONS: Our study has demonstrated that although neonates with both symmetric and asymmetric intrauterine growth restriction had lower left ventricular dimensions, relative posterior wall thickness, left ventricular mass, and mass index when compared with appropriate for gestational age neonates, left ventricular systolic functions were found to be preserved. In our study, low socio-economic level, short maternal stature, and low maternal weight were found to be risk factors to develop intrauterine growth restriction. To our knowledge, our study is the first to evaluate left ventricular dimensions, wall thicknesses, mass, and systolic functions in neonates with intrauterine growth restriction and compare results with respect to asymmetric or symmetric subgroups.

Neuroinflammation in the fetus exposed to maternal obsessive-compulsive disorder during pregnancy: a comparative study on cord blood tumor necrosis factor-alpha levels.

OBJECTIVE: The relationship between maternal psychiatric disorders and fetal neurodevelopment is unclear. Obsessive-compulsive disorder (OCD) is relatively frequent during pregnancy. The study aimed to investigate whether maternal OCD during pregnancy affects fetal circulating tumor necrosis factor-alpha (TNF-α) levels, an important pro-inflammatory cytokine, by comparing cord blood TNF-α levels in newborn infants of women with and without OCD. METHODS: The study sample included 7 women with OCD and 30 healthy women. OCD and other psychiatric diagnoses were screened by means of the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. The blood sample for the determination of TNF-α level was obtained from the umbilical cord during delivery. RESULTS: Cord blood TNF-α levels in newborn infants exposed to maternal OCD were significantly higher compared to non-exposed infants. Maternal anxiety symptom level was found to positively correlate with cord blood TNF-α levels in newborn infants of women with OCD. CONCLUSION: The study results imply that maternal OCD during pregnancy may lead to neuroinflammation in the developing fetal brain through higher levels of circulating TNF-α.

Isolated left ventricular noncompaction in a newborn with Pierre-Robin sequence.

Pierre-Robin sequence or syndrome (PRS) (OMIM #261800) is characterized by a small mandible (micrognathia), posterior displacement/retraction of the tongue (glossoptosis), and upper airway obstruction. It has an incidence varying from 1 in 8,500 to 1 in 30,000 births. Congenital heart defects (CHDs) occur in 20 % of the patients with PRS. Ventricular septal defect, patent ductus arteriosus, and atrial septal defects are the most common lesions. Noncompaction of the ventricular myocardium is a rare cardiomyopathy characterized by a pattern of prominent trabecular meshwork and deep intertrabecular recesses. It is thought to be caused by arrest of the normal endomyocardial morphogenesis. Isolated left ventricular noncompaction (LVNC) in patients with PRS has not been reported previously. This report describes a newborn with PRS and isolated LVNC. Previously, LVNC has been reported in association with mitochondrial disorders, Barth syndrome hypertrophic cardiomyopathy, zaspopathy, muscular dystrophy type 1, 1p36 deletion, Turner syndrome, Ohtahara syndrome, distal 5q deletion, mosaic trisomy 22, trisomy 13, DiGeorge syndrome, and 1q43 deletion with decreasing frequency. Karyotype analysis of the reported patient showed normal chromosomes (46, XX), and a fluorescent in situ hybridization study did not show chromosome 22q11.2 deletion. This is the first clinical report of a patient with isolated LVNC and PRS. Noncompaction of the ventricular myocardium is a rare and unique disorder with characteristic morphologic features that can be identified by echocardiography. Long-term follow-up evaluation for development of progressive LV dysfunction and cardiac arrhythmias is indicated for these patients.

Resistin--a novel feature in the diagnosis of sepsis in premature neonates.

OBJECTIVE: To evaluate the diagnostic potential of resistin in sepsis and to compare results with C-reactive protein (CRP) in infants < 32 weeks of gestation. STUDY DESIGN: A total of 64 infants were prospectively included in the study. Blood samples were collected for basal CRP and resistin within the first hour of life. When sepsis was suspected, samples were collected for CRP and resistin before the treatment was started (pretreatment CRP and resistin). On the third day of sepsis, CRP and resistin levels were measured for evaluating the treatment response (follow-up CRP and follow-up resistin). Culture-proven septic patients were divided into groups according to early or late-onset sepsis (EOS and LOS) and gram-negative or gram-positive sepsis (GNS and GPS). RESULTS: Pretreatment and follow-up resistin levels were significantly higher than basal resistin levels in both EOS and LOS groups (p < 0.01), with a positive correlation with CRP levels. To predict the GNS and GPS area under curve, values of pretreatment CRP and resistin were 0.714 and 0.984, respectively (p = 0.039). CONCLUSION: Resistin had a superior potential to that of CRP in the diagnosis of sepsis in preterm infants. Resistin may be used as an early marker for sepsis in premature infants.

The haemodynamic effects of umbilical cord milking in term infants: a randomised controlled trial.

Introduction: Umbilical cord milking (UCM) is a method that allows for postnatal placental transfusion. The benefits of UCM have been demonstrated in some studies, but knowledge about its haemodynamic effects in term infants is limited. The aim of this study was to evaluate the haemodynamic effects of UCM in term infants. Methods: In this prospective, randomised controlled study, 149 healthy term infants with a birth week of ≥37 weeks were randomly assigned to either the UCM or immediate cord clamping (ICC) group. Blinded echocardiographic evaluations were performed in all the neonates in the first 2-6 h. Results: Superior vena cava (SVC) flow measurements were higher in the UCM group compared to the ICC group (132.47 ± 37.0 vs. 126.62 ± 34.3 mL/kg/min), but this difference was not statistically significant. Left atrial diameter (12.23 ± 1.99 vs. 11.43 ± 1.78 mm) and left atrium-to-aorta diastolic diameter ratio (1.62 ± 0.24 vs. 1.51 ± 0.22) were significantly higher in the UCM group. There were no significant differences in other echocardiographic parameters between the two groups. Conclusion: We found no significant difference in the SVC flow measurements in term infants who underwent UCM versus those who underwent ICC. This lack of significant difference in SVC flow may be explained by the mature cerebral autoregulation mechanism in term neonates.

Vestibular evoked myogenic potentials in term newborn infants with severe hyperbilirubinemia.

BACKGROUND: The aim of this study was to determine the effects of severe hyperbilirubinemia on vestibular evoked myogenic potentials (VEMP). METHODS: A prospective study was designed. Seventeen term infants who suffered from severe hyperbilirubinemia in the first 5 postnatal days of age were included in the study group. The control group consisted of 17 healthy term infants. Audiological evaluation was performed, including tympanometry and transient evoked otoacoustic emissions, and VEMP tests. RESULTS: All newborns passed audiological evaluation. Biphasic waveforms of VEMP were obtained in all of the 34 infants who had been tested. Both latencies of p13 and n23 were significantly delayed in the severe hyperbilirubinemia group (P < 0.05). CONCLUSION: This pilot is the first study to show that severe hyperbilirubinemia causes delay in VEMP latencies. We suggest that severe hyperbilirubinemia might affect the vestibular nuclei or the integrity of the inferior vestibular nerve and vestibulospinal tract. Further studies need to explain the relation between hyperbilirubinemia and the vestibular system.

Discordant ROP (Retinopathy of prematurity) development in twins less than 32 weeks of gestational age.

BACKGROUND AND AIM: Retinopathy of prematurity (ROP), is a vasoprolipherative disorder of the immature retina and a major cause of preventable blindness in childhood. Although the development of ROP is multifactorial, the main reasons are lower gestational age and birth weight. However, in twins their gestational ages were the same, ROP development can be discordant. This study aims to evaluate the etiologic factors of discordant ROP development in twins. METHODS: We reviewed the last 5 years' records and found the twins whose discordant ROP development. This discordance was; 1. Different stages of ROP, 2. One sibling treated the other is not, 3. One sibling has aggressive posterior ROP the other is not, 4. one sibling has more influenced area as zones the other is not. We documented some data of these twins, as birth order, birth weight, resuscitation at birth, morbidities, the number of hemotransfusion, age of regaining birth weight, relative weight gain at 28 weeks. RESULTS: A total of 26 cases of 13 twins were evaluated. The mean gestational age and birth weight of the whole study group were 27.7 ± 2, and 1053 ±  364 grams, respectively. We found that more transfused preterm baby in twins is more likely to show severe ROP. Additionally, sepsis and the duration of mechanical ventilation may be risk factors for more severe ROP in twins. CONCLUSIONS: We can reduce discordant retinopathy in less than 32-weeks premature twins by using methods such as cord milking and by improving non-invasive ventilation modalities.

Intravenous Immunoglobulin Use in Hemolytic Disease Due to ABO Incompatibility to Prevent Exchange Transfusion.

Introduction: Intravenous immunoglobulin (IVIG) has been widely used to treat the hemolytic disease of the newborn (HDN). Although it has been shown that IVIG treatment reduces the duration of phototherapy and hospitalization, the use of IVIG in hemolytic disease due to ABO incompatibility has been controversial in recent years. This study aimed to investigate the role of IVIG in the prevention of exchange transfusion in infants with ABO HDN who presented with bilirubin levels at or above the level of exchange transfusion. Materials and Methods: This study evaluated the data of infants with ABO HDN in the Turkish Neonatal Jaundice Online Registry. The infants with ABO HDN who met the total serum bilirubin level inclusion criteria (within 2-3 mg/dL of exchange transfusion or even above exchange transfusion level) were included in the study according to the guidelines from the American Academy of Pediatrics and the Turkish Neonatal Society. All patients were managed according to the unit protocols recommended by these guidelines and received light-emitting diode (LED) phototherapy. Infants who only received LED phototherapy, and who received one dose of IVIG with LED phototherapy were compared. Results: During the study period, 531 term infants were included in the study according to inclusion criteria. There were 408 cases in the phototherapy-only group, and 123 cases in the IVIG group. The demographic findings and the mean bilirubin and reticulocyte levels at admission were similar between the groups (p > 0.05), whereas the mean hemoglobin level was slightly lower in the IVIG group (p = 0.037). The mean age at admission was earlier, the need for exchange transfusion was higher, and the duration of phototherapy was longer in the IVIG group (p < 0.001, p = 0.001, and p < 0.001, respectively). The rate of re-hospitalization and acute bilirubin encephalopathy (ABE) was higher in the IVIG group (p < 0.001 and p = 0.01, respectively). Conclusion: In this study, we determined that one dose of IVIG did not prevent an exchange transfusion nor decrease the duration of phototherapy in infants, who had bilirubin levels near or at exchange transfusion level, with hemolytic disease due to ABO incompatibility.

Effects of delayed umbilical cord clamping on peripheral blood hematopoietic stem cells in premature neonates.

AIM: To investigate the effects of delayed cord clamping (DCC) on peripheral hematopoietic progenitor cells (HPCs) and hematological parameters in premature infants (<32 weeks) during the neonatal period. METHODS: This was a prospective, randomized, and controlled, single-center study. Prior to delivery, 21 infants were randomly assigned to immediate cord clamping (ICC) at 5-10 s and 21 infants to DCC at 30-45 s. One milliliter blood sample was taken in the first 30 min of life. HPCs were measured by three-color flow cytometry using monoclonal antibodies. RESULTS: There were no significant differences between groups in either maternal or neonatal demographics. All HPC counts were higher in the ICC group, but the difference was not significant. CD34+ cell counts were 45.3 ± 36.6/µL in the ICC and 33.2 ± 26.6/µL in the DCC group (P=0.33); multi-potent progenitor cell counts were 43.2 ± 35/µL in the ICC and 31.1 ± 26.6/µL in the DCC group (P=0.28); and hematopoietic stem cell counts were 2.1 ± 2.1/µL in the ICC and 2.1 ± 3.1/µL in the DCC group (P=0.66). CONCLUSION: Contrary to our expectation, all HPC counts were lower in the DCC group.

Is Less Invasive Surfactant Administration a Beneficial Method for Late Preterm Infants?

BACKGROUND: Late preterm infants (LPIs) have increased steadily in all newborns delivery and they are the largest patient group requiring admission to the neonatal intensive care unit. Surfactant treatment is frequently used in LPIs in case of respiratory distress, but the procedure and the timing of surfactant administration are not well-known. OBJECTIVE: We aimed to evaluate the effect of surfactant administration techniques on pulmonary outcomes in LPIs with respiratory distress. METHODS: In this retrospective study, we compared the effects of the less invasive surfactant administration (LISA) technique and conventional treatment on respiratory and other morbidities in LPIs who have respiratory difficulties. We named these two groups as the LISA group and the conventional group (CG). Comparison of the mechanical ventilation (MV) rates between the groups was the primary outcome of our study. RESULTS: There were 25 LPIs in each group. The duration of nasal continuous positive airway pressure (CPAP) and oxygenation were similar in both groups. The rate of MV and the duration of MV (P=0.004 and P=0.02) were lower in the LISA group. Also, the need for more than 1 dose of surfactant was higher in the MV requiring group, although it was not statistically significant between the groups (P=0.21). CONCLUSION: Using the LISA technique for surfactant instillation reduces any MV requirement. LISA is a very useful and reliable technique in experienced hands in LPIs as in very preterm infants.

Prophylactic intravenous paracetamol use in extremely premature infants for patent ductus arteriosus.

OBJECTIVES: Patency of ductus arteriosus (PDA) is a very common problem among extremely low birth weight infants (ELBW). Hemodynamic instability caused by PDA is associated with important morbidities. This study aims to evaluate the effects of prophylactic intravenous paracetamol on the hemodynamically significant patent ductus arteriosus (hsPDA). METHODS: A total of 75 infants of <28 week-gestational age were enrolled into the study which was retrospective. Prophylactic paracetamol as the experimental group and none-prophylaxis group as the control group were compared in the study. RESULTS: There were 35 subjects in the prophylactic paracetamol group (PPG), and 40 in the control group. Primary outcome measures were ductal closure, ductal diameter, grade 3-4 IVH, and repeated ibuprofen need for the treatment of hsPDA. At the time of the evaluation by echo, hsPDA, and the diameter of the ductus higher than 1 mm were found significantly lower in the PPG (p=0.004 and p=0.013). Additionally, the repeated course of ibuprofen was significantly lower in the PPG (p=0.025). Secondary outcomes were the other perinatal morbidities. According to the results of the study, the male gender is 6.6, and the paracetamol use is 5.5 times more likely to suffer from ROP. CONCLUSIONS: The results of the study indicated that prophylactic paracetamol use in ELBW infants decreases the likelihood of hsPDA. The repeated course of ibuprofen for the treatment of hsPDA can be reduced. Furthermore, it can be understood that while prophylactic use of paracetamol is preventive for intraventricular hemorrhage, it does not function in the same way for retinopathy of prematurity or bronchopulmonary dysplasia. It might even worse the retinopathy of prematurity. Further prospective randomized controlled and larger sample-sized studies are needed.

Vestibular evoked myogenic potentials in preterm infants.

The goal of this study was to determine whether there was an association between perinatal risk factors of prematurity and vestibular evoked myogenic potentials (VEMPs). A prospective case-control trial was designed. Fifty preterm newborns (100 ears) with a gestational age <37 weeks were included. The control group consisted of 20 healthy term infants (40 ears). VEMP recordings were performed, and mean latencies of p13 were calculated in all study subjects. Multivariable logistic regression was used to investigate the influence of perinatal variables on abnormal VEMP responses. VEMPs were elicited in all term infants (40 ears). In preterm infants, the responses were normal in 71 ears, delayed in 24 and absent in 5. There was a significant difference between abnormal VEMP rates for preterm and term infants (p < 0.001). Asphyxia (OR = 13.985, p = 0.048) and time of VEMP test (OR = 0.865, p = 0.038) were related to abnormal VEMP responses. There was no association between delayed VEMPs and gestational age, birth weight, hemoglobin and bilirubin levels, phototherapy, intracranial hemorrhage, convulsions, sepsis, ototoxic drugs, transfusion, mechanical ventilation, retinopathy of prematurity, bronchopulmonary dysplasia and respiratory distress syndrome. These results suggest a delay in the maturation of VEMPs in premature infants. Asphyxia was the most important risk factor for abnormal VEMP responses in preterm infants.

Erythrocyte transfusions and serum prohepcidin levels in premature newborns with anemia of prematurity.

Hepcidin is a regulatory peptide hormone acts by limiting intestinal iron absorption and promoting iron retention. Determining the level of hepcidin in anemia of prematurity might be important in preventing iron overload. This study aimed to determine serum levels of prohepcidin in newborns with anemia of prematurity, to assess the effect of a single erythrocyte transfusion on serum prohepcidin levels, and to determine the possible relationships between prohepcidin levels and serum iron and complete blood count parameters. Nineteen premature newborns with anemia of prematurity who had been treated with erythrocyte transfusions were included in this study. Just before, and 48 hours after, each transfusion, venous blood samples were collected from patients. Serum prohepcidin levels before and after erythrocyte transfusion were 206.5+/-27.3 and 205.7+/-47.1 ng/mL, respectively; no statistically significant differences were found. No significant differences existed before or after transfusion regarding serum total iron and ferritin levels, iron-binding capacity, or mean corpuscular hemoglobin concentration. No significant correlations existed between serum prohepcidin levels and other parameters, either before or after transfusions. Our results showed that there were no statistically significant differences between serum prohepcidin levels before and after a single erythrocyte transfusion in premature newborns.

Ultrasound-Guided versus Conventional Caudal Block in Children: A Prospective Randomized Study.

BACKGROUND: Injection to the accurate area without any complications is the main factor for the efficiencies of caudal block. The aim of this study was to compare success and the complications of conventional and ultrasound method for caudal block in children. MATERIALS AND METHODS: Two-hundred sixty-six American Society of Anesthesiologists (ASA) category 1 children aged between 6 months and 6 years undergoing hypospadias, circumcision, or both surgeries were randomly allocated two groups (Group C or Group H, n = 133). About 0.25% bupivacaine with 1/200000 adrenaline (total volume: 0.5 mL/kg) was injected after the needle was inserted into the sacral canal in Group C, or right after the needle pierced the sacrococcygeal ligament under longitudinal ultrasound view in Group H. Success rate of block, block performing time, number of needle puncture, success at first puncture, complication rate, age and weight of the patients encountering these complications were recorded. RESULTS: The success rate of block was similar between two groups (94.7% in Group C vs 96.2% in Group U, p > 0.05). Success at first puncture was higher in Group U than in Group C (90.2 vs 66.2%, respectively; p < 0.001). Number of needle puncture, blood aspiration, subcutaneous bulging, and bone contact was higher in Group C but none in Group U (p < 0.001) and these complications were occurred in children weighing < 16 kg and less younger than 6 years old. CONCLUSION: We observed that the complications were not encountered, number of needle puncture was lesser, and the success rate of first puncture was higher under ultrasound with longitudinal view.

Effect of Maternal Depression on Brain-derived Neurotrophic Factor Levels in Fetal Cord Blood.

OBJECTIVE: : We aimed to assess the association between cord blood brain-derived neurotrophic factor (BDNF) concentration and maternal depression during pregnancy. METHODS: : A total of 48 pregnant women, admitted for elective caesarean section to Department of Obstetrics and Gynecology, The Konya Research and Training Hospital and Konya Necmettin Erbakan University Meram Medical Faculty, were included in this study. The study group included 23 women diagnosed as having depression during pregnancy and the control group included 25 pregnant women who did not experience depression during pregnancy. RESULTS: : The groups had similar sociodemographic characteristics. Cord blood BDNF concentration was significantly lower in babies born to mothers with major depression as compared with those in the control group. We didn’t find any correlation between the umbilical cord blood BDNF levels and BDI scores. CONCLUSION: : The results suggest that the existence of major depression in pregnant women may negatively affect fetal circulating BDNF levels.

Early neonatal outcomes of very-low-birth-weight infants in Turkey: A prospective multicenter study of the Turkish Neonatal Society.

OBJECTIVE: To investigate the early neonatal outcomes of very-low-birth-weight (VLBW) infants discharged home from neonatal intensive care units (NICUs) in Turkey. MATERIAL AND METHODS: A prospective cohort study was performed between April 1, 2016 and April 30, 2017. The study included VLBW infants admitted to level III NICUs. Perinatal and neonatal data of all infants born with a birth weight of ≤1500 g were collected for infants who survived. RESULTS: Data from 69 NICUs were obtained. The mean birth weight and gestational age were 1137±245 g and 29±2.4 weeks, respectively. During the study period, 78% of VLBW infants survived to discharge and 48% of survived infants had no major neonatal morbidity. VLBW infants who survived were evaluated in terms of major morbidities: bronchopulmonary dysplasia was detected in 23.7% of infants, necrotizing enterocolitis in 9.1%, blood culture proven late-onset sepsis (LOS) in 21.1%, blood culture negative LOS in 21.3%, severe intraventricular hemorrhage in 5.4% and severe retinopathy of prematurity in 11.1%. Hemodynamically significant patent ductus arteriosus was diagnosed in 24.8% of infants. Antenatal steroids were administered to 42.9% of mothers. CONCLUSION: The present investigation is the first multicenter study to include epidemiological information on VLBW infants in Turkey. Morbidity rate in VLBW infants is a serious concern and higher than those in developed countries. Implementation of oxygen therapy with appropriate monitoring, better antenatal and neonatal care and control of sepsis may reduce the prevalence of neonatal morbidities. Therefore, monitoring standards of neonatal care and implementing quality improvement projects across the country are essential for improving neonatal outcomes in Turkish NICUs.

Invasive Candida albicans infection mimicking leukemia in a neonate.

Congenital leukemia is rare, and is frequently diagnosed as a form of acute myeloid leukemia at, or immediately after birth. Some infections, viral in particular, can mimic clinical signs and/or laboratory findings of congenital leukemia. This is the first documented case of candidemia resembling leukemia.

Clinical application of vestibular evoked myogenic potentials in healthy newborns.

OBJECTIVE: Auditory and vestibular functions have critical importance in infancy because they may affect motor and mental development. We aimed to determine the normal values of the vestibular evoked myogenic potential (VEMP) parameters to provide a reference for further research regarding the early diagnosis of vestibular dysfunction in newborns. METHODS: Twenty-four term newborns (12 girls, 12 boys), with birth weights greater than 2500 g and Apgar scores higher than 7 at 1 min, were studied. Tympanometry, auditory-evoked brainstem responses, transient-evoked otoacoustic emissions, and VEMP recordings were assessed in all subjects during fourth week after birth. RESULTS: All newborns passed the audiologic evaluation, and biphasic waveforms of the VEMP were obtained in all 48 tested ears. Mean latencies of p13, n23, and p13-n23 intervals were 13.7+/-1.1, 20.5+/-1.6, and 7.1+/-2.1 ms, respectively. The mean amplitude value was 22.6+/-18.4 microV. There were no significant differences in latency values or amplitudes with regard to sex or side of ear tested in newborns. CONCLUSIONS: VEMP may easily be used for early evaluation of vestibular dysfunction in newborns. Because results may differ owing to test techniques and age, every laboratory should have its own normal values.